Fighting Ovarian Cancer: The Search For Better Outcomes

Contrary to popular belief, ovarian cancer is actually not a silent killer. There are certain indicators; it’s just that the way they manifest is usually mistaken for something else. As a result of this, the disease continues to take the lives of around 15,000 women each year in the United States, most of whom are diagnosed at a late stage.

Despite this fact, we can still be hopeful of the future. The latest progress in therapy has introduced us with three new drugs named PARP inhibitors. These are especially effective for those with inherited BRCA1 or BRCA2 mutations, which is responsible for nearly 15 percent of all ovarian cancers. When combined with old therapies, these drugs are showing promising results.

There’s still more to do to catch and quash this killer. Researchers continue on their quest to unlock the mysteries of ovarian cancer: screening and early detection; finding patients who respond quickly to standard chemotherapies and those who don’t and creating new treatments to beat advanced diseased.

Recognizing The Symptoms

The stealth nature of ovarian cancer poses as the biggest challenge. Studies on symptoms and screening tools are key to assessing the disease at an early stage. In their new study, Dr. M. Robyn Andersen and Dr. Barbara Goff of the Hutch and the University of Washington were able to provide guidelines for physicians in checking for the disease.

Prior to their work, many doctors believed that ovarian cancer was a silent killer and showed no symptoms. The duo found that a large percentage of women reported signs and were able to talk about them in adequate detail, avoiding ambiguity.

The ovarian symptom index asks women about increased abdomen size and/or bloating, pelvic and/or abdominal pain, and changes in eating habits because of “feeling full.” All of these were identified as signs of ovarian cancer. Less common indications include lack of energy, constipation, vaginal bleeding, or diarrhea.

Andersen suggests going to the physician if the symptoms are frequent, continual, and new to them in the past year. Women who get a positive score on the index may go through further evaluation with a blood test for biomarker CA-125 and a transvaginal ultrasound.

The Role Of Biomarkers In Early Detection

There is still a risk for some women to not experience symptoms until the cancer has progressed. We currently look for CA-125 in the blood test to see an indication of the disease. However, there could be additional blood biomarkers that we can use to reliably screen for ovarian cancer.

In a 2015 study, a group of scientists was able to identify another blood-based biomarker known as the human epididymis 4 protein or HE4. This aids in predicting epithelial ovarian cancer in some women. More biomarker work plans to use a DNA sequencing tool called CypherSeq to look for rare mutations.

The device is proven to be more sensitive than other methods and medical professionals are hoping to use it to detect, through a PAP smear, a specific mutation that’s a hallmark of high-grade serous cancers. The HGSCs are the most common and lethal subtype of ovarian cancer. Detecting them early is crucial to successful treatment.

Getting Around Chemo Resistance

Many women diagnosed with ovarian cancer are given platinum chemotherapy. However, the therapy may never work in some patients, making them suffer needlessly and without any health benefit. In 2017, the National Cancer Institute started a new project that used targeted proteomics and genomics to help filter those who will respond to therapy prior to chemo.

The Proteogenomic Translational Research Centers initiative revealed that 15 to 20 percent of patients that have tumors never respond to the chemo. After undergoing therapy, patients become too sick that they’re not eligible for a clinical trial. If healthcare providers can predict this lack of response early on, patients won’t have to waste their time on chemo that doesn’t work for them. They can enroll in a clinical trial and explore their options.

Proteogenomics is a promising approach for categorizing chemo-resistant patients ahead of time. The study of the body’s proteins and genomic sequencing may also help pinpoint new markers in for those whose tumors become resistant to the therapy over time. The next wave of research on human ovarian cancer is set to identify any predictors and pathways of tumors.

Immunotherapy On The Horizon

Prevention is not the only angle we’re looking at – scientists are working on possible cures for this deadly disease. A group of researchers from the Ludwig Institute for Cancer Research in Lausanne, Switzerland, discovered that certain ovarian tumors have T cells that are excellent at recognizing and killing cancer cells.

Getting these tumor-infiltrating lymphocytes and growing them to treat patients is not a new idea, but previous attempts have been unsuccessful. The Ludwig team then devised a new strategy to find “highly reactive” TILs and expand them in a way that enriches instead of diluting them.

The team learned that the manipulated killer TILs from ovarian tumors were significantly better at spotting mutated antigens than the TILs derived from the blood. What’s more, 90 percent of the ovarian cancer patients they studied had highly reactive killer T-cells. This remarkable finding suggests that such a therapy would be widely applicable.

Several biotech companies and research groups are looking for ways to cure solid tumors with engineered immune cells. A team from the University of Carolina is homing in on a new CAR-T target that could make therapy more effective for glioblastoma, the most aggressive of brain tumors. The University of Texas MD Anderson Cancer Center and Lion Biotechnologies are also working on a TIL approach to ovarian and pancreatic cancer.

Hope For The Future

There are moments in cancer research history when science moved so slowly. Many patients are in urgent need for treatment, but now we know that it can be a fatal mistake to put them through treatment that doesn’t work for them. With the recent research findings, we become more aware of the tools that will give people real hope.

"New Hope empowered me and my husband through education and support to change our lives, making cancer an experience that made us stronger and better people ... I thank God we made the decision to go to New Hope. My husband Barry (now cancer free) & I highly recommend New Hope to patients and champions alike who are facing this modern day illness ..." -- Laura Hilton